High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates from the National Health Interview Survey, 2016June 6, 2017
Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates from the National Health Interview Survey, 2016”
Q: Can you explain what high-deductible health plans (HDHP) are and why did you decide to look at this?
RC: High-deductible health plans (HDHP) are health insurance policies with higher deductibles than traditional plans. In 2016, a HDHP was defined as a health plan with an annual deductible of at least $1,300 for self-only coverage or $2,600 for family coverage. Traditional plans have annual deductibles below these levels. Relative to traditional plans, HDHPs tend to have lower premium costs. Because of the higher deductibles, persons enrolled in HDHPs can have higher out-of-pocket costs in the initial stages of care. We wanted to examine whether persons enrolled in HDHPs were more likely to forgo or delay care due to cost.
Q: How has the percentage of U.S. adults aged 18–64 with employment-based coverage enrolled in a HDHP changed from 2011-2016?
RC: The percentage of adults aged 18–64 with employment-based coverage enrolled in an HDHP increased from 26.3% in 2011 to 39.3% in 2016.
Q: What did your report find out among privately insured adults aged 18–64 with HDHPs?
RC: In 2016, among privately insured adults aged 18–64, the percentage of those who did not get or delayed needed medical care due to cost in the past 12 months was significantly higher for those with an HDHP than those with a traditional plan.
Q: Was there anything in your report that surprised you?
RC: Regardless of the type of directly purchased coverage, adults with directly purchased coverage were more likely to not get or delay medical care due to cost than those with employment-based coverage.
Q: What is the take home message from this report?
RC: Among adults with private health insurance, those who have HDHPs are more likely to experience cost-related barriers to health care.
Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016May 16, 2017
Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016”
Q: Have the total number of uninsured leveled off since the Affordable Care Act (ACA) was implemented?
RC: In 2016, 28.6 million or 9.0% of persons of all ages were uninsured at the time of interview, this is 20 million fewer persons than in 2010 and no change from 2015. However, it is too soon to tell if there has been a leveling off in the number of uninsured.
Q: Since 2010, were there any trends among uninsured adults by age groups?
RC: Among adults aged 18–64, the rate of uninsurance at the time of interview remained relatively stable from 2010 through 2013 for all age groups except adults aged 18–24. Among adults aged 18–24 the percentage of those who were uninsured decreased from 31.5% in 2010 to 25.9% in 2011, and then remained stable through 2013. For all age groups, the percentage who were uninsured decreased significantly from 2013 through 2016.
Q: What did your report find on state-specific health insurance estimates for 2016?
RC: State-specific health insurance estimates for persons aged 18–64 in 2016 are presented for 45 states. Among these 45 states presented for 2016, California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Michigan, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Washington, and Wisconsin had significantly lower percentages of uninsured adults than the national average (12.4%). Florida, Georgia, Idaho, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, and Texas had significantly higher percentages of uninsured adults than the national average. Among the 45 states presented in this report, only California had a significant decrease in the percentage of adults aged 18–64 who were uninsured between 2015 (11.1%) and 2016 (9.5%).
Q: How come you only have data for 45 states instead of the whole country?
RC: Estimates are not presented for all 50 states and the District of Columbia due to considerations of sample size and precision. States with fewer than 1,000 interviews for persons of all ages are excluded. In addition, estimates for children in states that did not have at least 300 children with completed interviews are not presented.
Q: Was there anything in your report that surprised you?
RC: The percentage of persons aged 18–64 who were enrolled in exchange plans has remained relatively stable from the first quarter of 2016 (4.7% or 9.2 million) through the fourth quarter of 2016 (4.8% of 9.4) million. This was surprising because for both 2014 and 2015 we observed a drop in exchange coverage in the fourth quarter.
Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016April 27, 2017
Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016.”
Q: What do you mean by the “chronically uninsured?”
EZ: For the purposes of this report, persons were defined as chronically uninsured if they were uninsured at the time of interview and had lacked coverage for more than 1 year.
Q: What groups are more likely to be chronically uninsured?
EZ: We have to be careful about how we speak about the results of this report. The focus of this report is the population who are chronically uninsured. Therefore it does not address which groups are more likely to be chronically uninsured. Among the chronically uninsured, certain groups are larger than others. In the first 9 months of 2016, the proportion of chronically uninsured adults who lived in the South was larger than the proportion who lived in the Northeast, Midwest, or West regions. The proportion who were aged 45-64 was larger than the proportion who were aged 18-25, 26-34, and 35-44. The proportion who were Hispanic was larger than the proportion who were non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and non-Hispanic other race. The proportion who rated their health as excellent or very good was larger than the proportion who rated their health as either good or fair or poor. A major focus of this report is how these proportions have changed since 2010.
Q: How many of the chronically uninsured are younger people who in many cases are healthy vs. older people who are much more likely to need insurance?
EZ: In the first 9 months of 2016, we estimate that 16% of chronically uninsured adults aged 18-64 were aged 18-25, 25.2% were aged 26-34, 26.8% were aged 35-44, and 32% were aged 45-64. Since 2010, the proportion of chronically uninsured adults who were aged 18-25 has decreased, and the proportion who were aged 35-44 and 45-64 increased. For this report, we did not disaggregate health status by age.
Q: Are there more chronically uninsured people in states that did not expand Medicaid?
EZ: We did not look at the chronically uninsured population stratified by state Medicaid expansion status for this report. However, we do look at the percent who are uninsured at the time of interview, which includes both chronically and short-term uninsured, by state Medicaid expansion status in our quarterly Health Insurance Early Release report. The percentage who are uninsured is higher in states which have not expanded Medicaid, compared with states which have expanded Medicaid.
Q: What in this new analysis did you find most interesting?
EZ: The first figure in our report shows that since 2010, the percentage of adults aged 18-64 who are chronically uninsured has been cut by more than half from 16.8% in 2010 to 7.6% in the first 9 months of 2016.
Q: When will you have full-year numbers available for 2016?
EZ: Full year 2016 Early Release data will be available on May 17th, 2017 through the Research Data Centers. That’s also when the next Health Insurance Early Release report will come out. Full year final data are expected to be released at the end of June 2017, six months after the completion of data collection.
Q: What do you make of the finding that the percent of chronically uninsured who are unemployed has been dropping while the percent who are employed has been increasing?
EZ: We don’t propose potential explanations for the results of this report, that’s outside of the scope of our work, but we did see a decrease in the proportion of chronically uninsured adults aged 18-64 who were unemployed from 16.3% in 2010 to 10.1% in the first 9 months of 2016, with a corresponding increase in the proportion who were employed during this time period.
Q: Anything else you feel is noteworthy about your study?
EZ: lthough the majority of chronically uninsured adults rate their health as excellent or very good, this proportion has not changed significantly from 2010 to the first 9 months of 2016. This means that the chronically uninsured population aged 18-64 is not more or less healthy (according to their self-rated responses) in the first 9 months of 2016 than in 2010.